Scapular Stabilization in Patients With Spinal Cord Injury

Abstract

Background: Severe scapular instability can be a considerable problem for people with high-level cervical spinal cord injury. Scapular instability reduces the effectiveness of the already weakened shoulder flexors and abductors, thereby limiting hand-to-mouth and hand-to-head activities. The winged scapula may cause inferior pole skin breakdown, as well as neck and shoulder pain. Objective: To report the efficacy of a fusionless scapular stabilization procedure as a means to enhance function in a consecutive group of patients with high-level cervical spinal cord injury. Methods: Four people with spinal cord injury at C4-C5 (2 male, 2 female; mean age 5 17.3 years, range 5 14-20 years) underwent scapular stabilization via scapulothoracic fusion (N 5 2) or by tethering the scapula to the rib cage with Mersilene tape as a fusionless stabilization (N 5 2). One patient died of unrelated causes 18 months after surgery, and the remaining 3 were followed for 26, 39, and 41 months, respectively. Data collection included radiographic analysis, active range of motion measures, and functional assessment. Results: Active shoulder flexion and abduction remained unchanged in 2 patients, but functional scores improved with regard to feeding and grooming capability. All patients reported satisfaction with postoperative appearance, and 3 patients reported considerable reduction in shoulder pain after surgery. Radiographs demonstrated maintenance of stable scapular alignment in all patients at final follow up. Wound breakdown, requiring removal of instrumentation, occurred in 2 patients. Conclusion: Scapular stabilization with or without fusion is a viable option to improve appearance, pain, and upper extremity function in people with high-level tetraplegia and scapular instability.

Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors

“…Future intervention studies for treatment and/or prevention should include a large, homogeneous study population, should have a long duration of follow-up time, and should include, if possible, a control group. Interesting would be to study the effects of earlier shoulder mobilization starting early after SCI by specialized physiotherapists paying attention not only on shoulder external rotation and abduction, but also to preserve shoulder flexion by, for example, scapula stabilization and mobilization 55 and balanced muscle training.…”

Upper limb kinematics after cervical spinal cord injury: a review

“…Fourth, shoulder ankylosis could reduce superiomedial and superior reach by reducting passive full range of motion by about 25° during both shoulder flexion and abduction compared with healthy individuals [ 38 , 44 ]. A final factor is shoulder pain, which is reported by more than half of the individuals with tetraplegia [ 46 ], and probably contributes to the functional limitation of the workspace.…”

Scapulothoracic Fusion With Nonmetallic Cables

“…The proposed immobilization period after scapulothoracic arthrodesis varies between 6 and 12 weeks, whereas it is significantly shorter (2 to 3 weeks) after scapulopexy and muscle transfers. A similar technique was recently used in 2 patients with spinal cord injury by Pahys et al 24 In addition to the technique described by Ketenjian, the authors tied Mersilene tapes over plates placed on the scapula and fixed the plate to the underlying rib with a screw. 11, 22 Overall, the prevalence rates of complications associated with the arthrodesis procedure vary and have been as high as 75% in the literature.…”

“…21,23,24 Fasciodesis also offers the advantage of early postoperative mobilization, which makes it more feasible in most clinical settings with scapular winging such as isolated nerve injuries and FSHD. 21,23,24 Fasciodesis also offers the advantage of early postoperative mobilization, which makes it more feasible in most clinical settings with scapular winging such as isolated nerve injuries and FSHD.…”